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Pathology The condition is more common on the right and is bilateral in 20% of cases. In adults, secondary sexual characteristics are typically normal. The testis may be: /uni25CF intra-abdominal; usually extraperitoneal just inside the internal inguinal ring;...

Pathophysiology Torsion of the testis is uncommon because the normal testis is anchored and cannot rotate. Extravaginal torsion is seen almost exclusively in neonates because of the increased mobility of the testicle before the descent into the scrotum when ...

Spermatocele This is a unilocular retention cyst derived from a portion of the sperm-conducting mechanism of the epididymis. A spermato - cele typically lies in the epididymal head above and behind the upper pole of the testis. It is usually softer and laxe...

Surgical treatment Orchidopexy Orchidopexy is usually performed between 6 and 18 months of age in an attempt to prevent the consequences described earlier. For premature babies, corrected age is used to determine surgery timing. The testis and spermatic cord ...

THE SCROTUM Fournier’s gangrene Fournier’s gangrene is an uncommon and nasty condition ( Figure 86.19 ) characterised by a polymicrobial infection of the soft tissues of the perineum, external genitalia and peri anal region. It is a form of necrotising fascii...

TORSION OF THE TESTIS De�nition Testicular torsion is the twisting of the spermatic cord and its contents such that the testicular blood supply becomes compromised. If left untreated the blood flow to the testicle ceases and the testicle dies. Testicular ...

TRAUMA TO THE TESTIS The testis can be damaged either by blunt or by penetrating trauma. Injuries can range from simple bruising, through significant intratesticular haematomas to rupture of the tunica albuginea, with very significant collections of blood withi...

Testicular tumours in children Paediatric testicular tumours are distinct from adult testicular tumours. GCTs in adults represent about 95% of all testicular tumours but only 60–75% in children. The most common malignant tumour in children is the yolk sac tu...

Treatment Varicocele repair can be e ff ective in men with a low sperm count, a clinical varicocele and otherwise unexplained infer tility . However, treatment of varicocele in adolescents poses a risk of overtreatment: most boys with a varicocele will have n...

Tuberculous epididymo-orchitis Chronic tuberculous epididymo-orchitis usually begins - insidiously . The frequency with which the lower pole of the - epididymis is involved first indicates that the infection is usually retrograde from a tuberculous focus in th...

VARICOCELE De�nition A varicocele is an abnormal dilatation and enlargement of the scrotal venous plexus draining the testis.

Varicoceles and infertility Varicoceles are present in 10–20% of adult men and in over 25% of men with abnormal semen analysis. The exact associa tion between reduced male fertility and varicocele is unknown. The most accepted theory is that increased blood fl...

ABNORMAL UTERINE BLEEDING IN THE NON-PREGNANT STATE Bleeding in the non-pregnant state may occur at the time of an expected menstrual period, between periods (intermen strual bleeding; IMB), after intercourse (postcoital bleeding; PCB) or following the menopau...

ACUTE ABDOMEN Abdominal pain is one of the most challenging presenting complaints in the emergency department. Common causes include: /uni25CF adnexal torsion; /uni25CF ovarian cyst accident, e.g. rupture; /uni25CF PID; /uni25CF endometriosis; /uni25CF append...

ANATOMY The reproductive structures of the dividing embryo di ff eren tiate after the seventh week of development. The gonads and internal and external genitalia constitute the sex organs. In the female, the Müllerian ducts develop into the uterus, fallopian ...

Adenomyosis Adenomyosis is a benign uterine disorder characterised by the presence of ectopic endometrium or endometrium-like struc - tures within the myometrium accompanied by smooth muscle hypertrophy or hyperplasia. The ectopic endometrium can be present e...

Adnexal torsion An adnexal torsion is commonly the result of an ovary , and occasionally a fallopian tube, twisting along its pedicle and interrupting its arterial supply , leading to ischaemia. Rapid identification and intervention are necessary to preserve ov...

CHRONIC ABDOMINAL PAIN Endometriosis Endometriosis is a common inflammatory condition and is diagnosed by the presence of endometrium-like tissue in extrauterine sites. The most commonly a ff ected sites are the pelvic organs and peritoneum, although distant sit...